Financial Coaching Application

Welcome to Modern Money Education!

Please take a moment to fill out this application for our coaching program. By doing so, we can ensure that we tailor our offerings to provide you with the utmost value and ensure a mutually beneficial fit. We are dedicated to delivering exceptional learning and empowerment experiences, which is why we are meticulous in selecting the groups of women we bring together. Once we have reviewed your application, we will promptly reach out to you via phone or email to discuss the next steps in the process.

Angela & Arielle

Modern Money Education
Primary Information
Name*

First NameLast Name
Age
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status
Employment Status
Company & Job Title
Spouse / Partner Information
Name

First NameLast Name
Age
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Employment Status
Company & Job Title
Household Information

Include amounts for both partners/ spouses
Financial Information
Total Income
Total Savings
Retirement, Bank Accounts, Investments
Total Debt
Which statements do you agree with? (Check all that apply)

Money will give me meaning.I don't deserve money.There will always be enough money.There will never be enough money.More money will make things better.Money is bad.The universe will supply for your needs.Money is unimportant.It's not nice to talk about money.
When it comes to money and managing my finances, I feel: (Check all that apply)

ExcitedHappyMotivatedEncouragedHopefulUninterestedOverwhelmedAshamedLazyAnxietyFearSadnessStressResentmentAvoidance
When it comes to budgeting:
When it comes to saving and investing:
Please describe your current financial process:
For example: Do you keep a written budget or spending plan? How often do you check your credit?
What are your areas of interest? (Check all that apply)

Money MindsetBudgetingCredit & DebtInsuranceEstate PlanningRetirementIncome TaxesBusiness PlanningMortgagesStudent LoansInvestingOther
What are the top 3 financial concerns or frustrations you'd like to address?
When it comes to money, I'm really good at:
Is there anything else you'd like for us to know?
Our fees range from $1,200 to $2,500 per month for our coaching programs. Are you prepared to invest this amount?

YesNo
Should be Empty:

Primary Information

Spouse / Partner Information

Household Information

Financial Information